The effect of call on neurosurgery residents' skills: implications for policy regarding resident call periods

Clinical article

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  • 1 Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois;
  • | 2 Simulation and Education Training Center, Banner Good Samaritan Medical Center, Phoenix; and
  • | 3 Department of Biomedical Informatics, Center for Cognitive Ubiquitous Computing, School of Computing and Informatics,
  • | 4 Arizona State University, Tempe, Arizona
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Object

Although fatigue and its effects on surgical proficiency have been an actively researched area, previous studies have not examined the effect of fatigue on neurosurgery residents specifically. This study aims to quantify the effect of fatigue on the psychomotor and cognitive skills of neurosurgery residents.

Methods

Seven neurosurgery residents performed a minimum of 3 and a maximum of 4 sessions of 6 surgical exercises precall and postcall. The simulation exercises were designed to measure a surgeon's cognitive abilities, such as memory and attention, while performing simulated surgical tasks and exercises that have been previously validated in several studies, including studies measuring the impact of fatigue on general surgery residents. Each exercise measured tool-movement smoothness, time elapsed, and cognitive errors. The change in surgical skills in precall and postcall conditions was assessed by means of an ANOVA, with p < 0.05 considered statistically significant.

Results

The neurosurgery residents did not show a statistically significant difference in their surgical skills between the pre- and postcall states (p < 0.3, p < 0.4, and p < 0.2 for movement smoothness, time elapsed, and cognitive errors, respectively). The mean decrement for all residents in the postcall condition was 13.1%.

Conclusions

Postcall fatigue is associated with a marginal decrease in proficiency during simulated surgery in neurosurgery residents. In a similar study, general surgery residents showed a statistically significant decrement of 27.3% in the postcall condition. The impact of fatigue on different specialties should be further investigated prior to implementation of a national physician work-hour policy.

Abbreviations used in this paper:

ACGME = Accreditation Council for Graduate Medical Education; PGY = postgraduate year.

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